Social Work Care Mgr II IP

Emory•Atlanta, GA

1d•Onsite

About The Position

The Social Work Case Manager II (SW CM) is responsible for patient care coordination from admission through discharge, ensuring smooth transitions of care as the patient is discharged from the hospital setting. This role focuses on facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning to foster efficient care delivery and maximize reimbursement. The SW CM initiates care coordination at admission by completing thorough assessments to enable timely and accurate information capture and discharge planning. As an integral part of the interdisciplinary care team, the SW CM attends rounds, care conferences, and/or care team meetings, representing both the hospital care team and the patient/family to balance patient/family choice with projected care coordination needs. The SW CM collaborates with the hospital care team and patient/family to plan and implement the best possible care plan, considering various factors, limitations, and preferences. They identify and recommend post-acute services, completing timely referrals to appropriate providers while coordinating with the patient/family and care team. Through continuous assessment, the SW CM applies critical thinking to ensure alignment and appropriateness of post-acute services as the patient clinically progresses. Ultimately, the SW CM ensures the discharge plan aligns with the patient's medically cleared for discharge date and the payor's projected length of stay. The role involves identifying and participating in strategies to reduce unnecessary length of stay and/or resource consumption, and escalating cases to management, Physician Advisor, Complex Care team, and/or Ethics committee as appropriate. The SW CM educates patients/families and the care team on post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources. They provide supportive and therapeutic communication to patients, families, and loved ones experiencing anxiety or stress due to illness, injury, or physical limitations, and respond to suspected violent, assault, abuse, and/or neglect cases in accordance with social work professional ethics. The SW CM must communicate confidently, effectively, and therapeutically, conveying a favorable impression of the organization. In collaboration with Utilization Review, the SW CM initiates and facilitates discussions with payors to advocate on behalf of the patient and hospital, aiming to reduce non-covered, non-authorized, or denied services. The SW CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for interpreting external regulations and organizational policies and procedures related to Discharge Planning and Care Coordination, ensuring compliance with all regulatory requirements for Government and Commercial Payors, third-party payers, federal and state regulatory agencies, and proper use of Case Management Systems and workflows.

Requirements

Must have a Masters in Social Work from an accredited Institution
LMSW license in the state of Georgia required
Must have working knowledge of software/Eemr applications
Must meet all quality and productivity expectations
Successfully complete yearly competencies

Nice To Haves

2 years recent healthcare experience preferred
Experience in Acute Care setting preferred
ACM, CCM preferred

Responsibilities

Responsible for patient care coordination from admission through discharge
Ensuring smooth transitions of care as the patient is discharged from the hospital setting
Ensuring and facilitating high quality clinical and cost outcomes
Procuring and securing post-acute services
Coordinating and advocating for patients and families with both internal and external stakeholders
Identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement
Begin the process of care coordination at the time of the patient’s admission by completing a thorough admission assessment and/or psychosocial assessment
Attend rounds, care conferences, and/or care team meetings
Act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services
Work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration
Identify and recommend post-acute services
Complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team
Apply critical thinking to ensure alignment and appropriateness of post-acute services as the patient clinically progresses throughout their stay
Ensure the discharge plan is aligned to be executed with the patient’s medically cleared for discharge date as well as the projected length of stay as provided by the payor
Identify and participate in the development of strategies to reduce unnecessary length of stay and/or resource consumption
Escalate cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee
Educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources
Provide supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations
Respond to suspected violent, assault, abuse and/or neglect cases in accordance with social work professional ethics
Communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization
Initiate and facilitate discussions with the payors to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services
Serve as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination
Ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors
Ensure compliance with all third party payers and federal and state regulatory agencies
Ensure proper use of Case Management Systems and workflows